Viscosupplementation Versus Corticosteroid Injection in Lumbar Facet Arthropathy: A Retrospective Comparative Study

Abstract

Background: Lumbar facet joint arthropathy is a common cause of low back pain, often treated with either corticosteroid injections or hyaluronic acid (HA) viscosupplementation. While both treatments are used in clinical practice, their comparative efficacy in managing facetogenic pain remains unclear.

Objective: To compare the efficacy of injected Hyaluronic acid versus Corticosteroids in the treatment of clinico-radiologically diagnosed lumbar facetogenic pain.

Methods: This was a single centre, hospital based retrospective study conducted in the Department of Orthopaedics, R L Jalappa Hospital & Research Center, associated with the Sri Devaraj Urs Medical College, Kolar, Karnataka between February 2023 and January 2024.

Results: This study included 36 participants in both the HA and Triamcinolone (TA) groups, with similar (P > 0.05) baseline characteristics such as age, gender, height, and weight. Regarding the severity of osteoarthritis, assessed using the Kellgren scale, no statistically significant differences were found across lumbar levels (P > 0.05). However, significant severity differences were noted, with lower lumbar levels exhibiting higher severity (P < 0.001). At baseline, pain scores were comparable between the HA and TA groups (P = 0.758). At 1 month, the TA group showed significantly lower pain scores compared to the HA group (P < 0.001). At 3 months, pain scores were similar between the groups (P = 0.792), but at 6 months, the TA group again had significantly lower pain scores (P = 0.001). Both groups showed significant improvement in pain scores over time (P < 0.001). For functional status, measured by the Roland Morris Questionnaire (RMQ), baseline scores were similar (P = 0.848). At 1 month, the TA group had significantly better functional improvement (P = 0.025), but by 3 months, the HA group showed better improvement (P = 0.039). By 6 months, the HA group maintained better functional outcomes compared to the TA group (P < 0.001), with significant overall improvements in both groups (P < 0.001).

Conclusion: While TA provided rapid and significant short-term pain relief and functional improvement, HA demonstrated a sustained effect on functional outcomes over six months.